COSCA Counsellor and Psychotherapist Accreditation DIPLOMA ROUTE APPLICATION

COSCA (Counselling & Psychotherapy in Scotland) 16 Melville Terrace Stirling FK8 2NE t: 01786 475 140 f: 01786 446 207 e: info@cosca.org.uk w: www.cosca.org.uk COSCA Counsellor and Psychotherapist Accreditation DIPLOMA ROUTE APPLICATION This is the Application for COSCA Counsellor/Psychotherapist Accreditation through the DIPLOMA ROUTE. Guidelines for the completion of this Application can be found on www.cosca.org.uk Accreditation Counsellor Diploma Route Guidelines CONTENTS APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E APPENDIX F APPENDIX G APPENDIX H Applicant s Personal Details, Disclosure and Declaration Submission Checklist Practice Log: Summary of Annual Practice Hours Practice Log: Summary of Recent Period of Work Frequency of Client Contact Transcript Pro Forma Supervision Sessions Supervisor s Report PAYMENT DETAILS January 2018 Page 1 of 22

APPENDIX A: APPLICANT S PERSONAL DETAILS, DISCLOSURE AND DECLARATION PART I: Personal Details Please indicate the date of the Guidelines to which your application refers. The Guidelines and Application Form used should be the most up to date version. These can be found on the COSCA website: www.cosca.org.uk Surname Forename(s) Address Post Code Telephone: Email: Practitioner Membership Reference Number: Have you previously applied for COSCA Counsellor/Psychotherapist Accreditation? If, please give date Counsellor Accreditation Workshops Please confirm if you have: Attended the COSCA Counsellor Accreditation System Workshop Viewed the COSCA Counsellor Accreditation System Online Workshop Video Office Use Date Received Payment January 2018 Page 2 of 22

Counselling/Psychotherapy Orientation(s): APPENDIX A: APPLICANT S PERSONAL DETAILS, DISCLOSURE AND DECLARATION Part II: Disclosure Information given below will not necessarily exclude you from accreditation. 1. Have you had membership of any professional counselling/psychotherapy body withdrawn? If, please give details. 2. Do you have any criminal or civil convictions (spent or unspent) or proceedings pending against you? If, please give details. 3. Do you have any professional complaint or disciplinary proceeding brought against you, which was successful or is currently pending? If, please give details. 4. Have you ever been listed as barred under the Protecting Vulnerable Groups Scheme/Disclosure Scotland? 5. Are you currently listed as barred under the Protecting Vulnerable Groups Scheme/Disclosure Scotland? January 2018 Page 3 of 22

APPENDIX A: APPLICANT S PERSONAL DETAILS, DISCLOSURE AND DECLARATION Part III: Declaration I declare that: 1. I am applying for COSCA Counsellor/Psychotherapist Accreditation, and agree to abide by COSCA s Guidelines and Criteria for the Accreditation of Counsellors and Psychotherapists, to be bound by COSCA s Memorandum and Articles of Association, and to abide by COSCA s Statement of Ethics and Code of Practice. 2. The evidence I have submitted gives an accurate portrayal of my training, practice, supervision and personal development in counselling. 3. I will inform COSCA of all criminal, civil, complaint or disciplinary proceedings brought against me in the future, which are relevant to my involvement with counselling. 4. I will provide such information as COSCA may require from time to time to confirm my continuing eligibility for Counsellor/Psychotherapist Accreditation. 5. I have appropriate and adequate public and professional liability insurance cover for all my counselling/psychotherapy work. 6. To the best of my knowledge and belief the information provided in this application is correct, and I understand that a failure to disclose on application or during the period of Accreditation, can lead to termination of my Counsellor/Psychotherapy Accreditation and COSCA Membership. 7. I will comply with COSCA s arrangements for handling complaints and concerns. (If you wish a copy of COSCA Complaints Procedure, please contact the COSCA office.) 8. I agree to my details being published in the COSCA Journal Counselling in Scotland on being awarded COSCA Counsellor/Psychotherapy Accreditation. Print Name: Signature: Date: January 2018 Page 4 of 22

APPENDIX B: SUBMISSION CHECKLIST **The Guidelines to assist with the completion of this Application can be found on www.cosca.org.uk Accreditation - Counsellor Content Relevant page in the Guidelines Document ** Appendices for submission * see below 1. Applicant s Details Page 8 A - Parts I, II and III 2. Submission Applicant s Personal Details Page 9 B Checklist 3. Core Evidence of Core Training Page 9 Training/Theoretical Knowledge Copies of Certificates Page 9 Core Orientation Statement Page 10 4. Therapeutic Alliance 1000 word Therapeutic Page 10 Alliance Statement 5. Practice Practice Log: Summary of Total Annual Practice Hours Page 11 Career Break Page 11 Summary of Recent Page 11 D Work Client Time Range Page 11 E Assessment Skills and Page 12 Referral System Statement Work Setting and Page 12 Arrangements Statement Evidence of Insurance Page 12 Case Study/ies Page 13 F Transcript 6. Supervision Supervision History Page 14 G 7. Continuing Professional Development 8. Reflective Current Supervision Page 14 G Supervisor s Report Page 15 H Evidence of CPD over last 3 years Personal Development Practitioner Statement 9. Ethics Evidence of Practitioner Membership of COSCA Page 16 Page 16 Page17 C A Included (tick) * Please include the appropriate page number from your application. January 2018 Page 5 of 22

APPENDIX C: PRACTICE LOG: SUMMARY OF ANNUAL PRACTICE HOURS Year Number of Practice Hours Work Setting Example: 2010 90 + 45 Agency + private Examples of work settings: NHS Private/independent Statutory agency i.e. prison, school Voluntary counselling service January 2018 Page 6 of 22

APPENDIX D: PRACTICE LOG: SUMMARY OF RECENT PERIOD OF WORK This table illustrates how the information might be shown. Week Date Client Details Session Number Session Length Focus of Session Private Agency Other Week 1 Week 2 Ref No. Gender Age 1.2.00 1 F 40 1 50 mins Distress at loss of husband Agency 1* 2 F 46 6 50 mins Fear of being alone Private 3 M 37 5 50 mins Wanting to leave partner Agency 2* 2.2.00 4 F 28 20 50 mins Working towards ending Agency 1* 5 F & M 40 + 41 10 50 mins Separating Private 8.2.00 1 2 50 mins Anxiety at responsibilities Agency 2* 2 7 50 mins Strategies of support Agency 1* 3 6 50 mins Last session, ending issues Agency 1* 9.2.00 4 21 50 mins Non attendance Private Etc. Etc. Etc. Etc. Etc. * Agency 1 = Bereavement Counselling Centre * Agency 2 = Relationship Counselling Centre January 2018 Page 7 of 22

APPENDIX E: FREQUENCY OF CLIENT CONTACT page 1 of 2 Over the past year, how many clients have you seen? Weekly Twice or more weekly Fortnightly Infrequently During the past year, how many clients have you seen for periods up to: 2 months or less 3 5 months 6 12 months 12 24 months More than 24 months January 2018 Page 8 of 22

APPENDIX E: FREQUENCY OF CLIENT CONTACT Page 2 of 2 How many clients in your counselling/psychotherapy career have you seen for more than 2 years? This form assists the Accreditation Panel by providing an overview of your work and by giving evidence by which congruence with skills, training and practice can be judged. It is not intended to discriminate against those who specialise in either short or long-term work. January 2018 Page 9 of 22

APPENDIX F: TRANSCRIPT PROFORMA Please provide: a 10 15 minute transcript from a session with the client(s) cited in the case study a considered reflection and analysis on the transcript The written reflection and analysis should demonstrate: what was going on for you as a counsellor/psychotherapist what kind of remarks you made as a counsellor/psychotherapist why you made them the broader rationale for the choice of your intervention. Clearly the content and issues arising within the transcript will be unique and will not necessarily provide the opportunity to demonstrate all of your competencies as a counsellor. However, the task is to demonstrate your abilities in all areas so that you are urged to use what does arise to the best advantage. Sample Applicant s Name: Time Dialogue Process Evaluation Time: Terms: Process: Please state where in session the excerpt is taken from. (Tape timings may be used) Please use the terms CO for Counsellor/Psychotherapist and CL for Client. To differentiate between counsellor/client dialogue please use bold italic for counsellor/psychotherapist dialogue. In this column please state what counsellor intervention/skill was used. Evaluation: Please evaluate effectiveness or non-effectiveness of intervention. Tape: Please retain a copy of your tape until you are satisfied it will not be required as part of your evidence. The Panel has the right to request a copy to listen to, if it is considered to be helpful for your application. Once you have been awarded Accreditation, all submission evidence is confidentially destroyed. January 2018 Page 10 of 22

APPENDIX G: SUPERVISION SESSIONS Page 1 of 2 Supervision History Supervision Log Year No. of Client Hours Number of Supervision Hours Individual Group Ratio Current Supervision (Individual Supervision) Current Supervisor Name: Duration Frequency Previous Supervisor Name Duration Frequency COSCA Reference January 2018 Page 11 of 22

APPENDIX G: SUPERVISION SESSIONS Page 2 of 2 Group Supervision Name of Supervisor Size of Group Duration Frequency If you have had additional group supervision, please copy this Appendix and complete as appropriate. January 2018 Page 12 of 22

APPENDIX H: SUPERVISOR S REPORT Page 1 of 9 It is your Supervisee s responsibility to provide you with: a copy of the COSCA s Guidelines and Criteria for the Accreditation of Counsellors and Psychotherapists the completed Diploma Route Application a copy of the COSCA Statement of Ethics and Code of Practice You are required to provide information on the following: that you have line managerial responsibility for the applicant If, please describe below your line management relationship with your supervisee and how you think that it is in line with paragraph 8 on Clientwork Supervision in the COSCA Statement of Ethics and Code of Practice : January 2018 Page 13 of 22

APPENDIX H: SUPERVISOR S REPORT Page 2 of 9 that you have a) received and b) read COSCA s Guidelines and Criteria for the Accreditation of Counsellors and Psychotherapists If to either a) or b) above, please provide an explanation below. that you have a) received and b) read the full Counsellor Accreditation application of your supervisee If to either a) or b) above, please provide an explanation below. January 2018 Page 14 of 22

APPENDIX H: SUPERVISOR S REPORT Page 3 of 9 that, as far as you know, the application submitted has been completed by your supervisee, including the case study and the transcript of a counselling session If, please provide an explanation below. that you consider that the above accreditation application of your supervisee meets all of the criteria for counsellor accreditation, including the criteria for the case study If, please state the specific criteria not met in the accreditation application and give your reason(s) for your view. January 2018 Page 15 of 22

APPENDIX H: SUPERVISOR S REPORT Page 4 of 9 that you have a) checked and b) verified as accurate all original documents submitted with this application, including those relating to the core training and qualifications of the applicant ` If to either a) or b) above, please provide an explanation below Where there is insufficient space for your answers, please attach extra sheets as necessary to the relevant pages. January 2018 Page 16 of 22

APPENDIX H: SUPERVISOR S REPORT Page 5 of 9 Name of Applicant: Supervisor s Details Surname Forename(s) Address Post Code: Telephone No: Email: Qualifications / training in counselling/psychotherapy and counselling supervision Please list your qualifications / training, giving names of awarding bodies and dates qualifications/training gained. January 2018 Page 17 of 22

APPENDIX H: SUPERVISOR S REPORT Page 6 of 9 Please state membership of professional body(s) Your experience in Counsellor/Psychotherapy Supervision Date of starting work as a Counsellor/Psychotherapist Supervisor: Number of Supervisees at present January 2018 Page 18 of 22

APPENDIX H: SUPERVISOR S REPORT Page 7 of 9 Do you consider that the applicant abides by the COSCA Statement of Ethics and Code of Practice? If, please explain How long have you been supervising the applicant s work? Please give your opinion of the present competence of the applicant s work including reference to the applicant s theoretical orientation and how this is applied in the therapeutic relationship. January 2018 Page 19 of 22

APPENDIX H: SUPERVISOR S REPORT Page 8 of 9 Do you consider the applicant to be ready at this time for accreditation by COSCA? If Yes, please give your reason(s) below. If No, please give details below. January 2018 Page 20 of 22

APPENDIX H: SUPERVISOR S REPORT Page 9 of 9 To be signed by the Supervisor: The case study, transcript and the application were written by the applicant I have not line managerial responsibility for the applicant Print Name Signature Date January 2018 Page 21 of 22

Payment COSCA Counsellor/Psychotherapist Accreditation fees and resubmission fess, if applicable, can be found on www.cosca.org.uk Costings. Payment requires to be received before the Panel meeting date. I am paying the Accreditation Fee of Direct to Bank: Clydesdale Bank PLC Sort Code: 82 68 05 Account Number: 70174110 Date paid to Bank: Cheque enclosed Please add 2.00 service charge Invoice required Please give invoice details if different from your own details. January 2018 Page 22 of 22